Variation in care practices across pediatric acute care cardiology units: Results of the Pediatric Acute Care Cardiology Collaborative (PAC3) hospital survey
Variation in care practices across pediatric acute care cardiology units: Results of the Pediatric Acute Care Cardiology Collaborative (PAC3) hospital survey
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DOI：
10.1111/chd.12739
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发表时间：
2019-05-01
影响因子：
0.3
通讯作者：
Tanel, Ronn E.
中科院分区：
文献类型：
--
作者：
Hoerst, Amanda;Bakar, Adnan;Tanel, Ronn E.
背景 小儿急症护理心脏病学协作组织 (PAC(3)) 成立于 2014 年，旨在提高重症监护病房以外医院心脏急症护理的质量、价值和体验。最初的 PAC(3) 项目是一项全面的调查，旨在了解整个协作组织的单位结构、实践和资源利用情况。本报告旨在描述成员机构之间以前未知的实践差异程度。方法 开发了 126 个主题的问题调查，涉及人口统计、人员配置、可用资源和治疗以及标准护理实践等 9 个领域的总共 412 个可能的回答字段。五个补充问题涉及手术病例量和心脏急症监护病房 (CACU) 入院人数。响应被记录并存储在研究电子数据捕获 (REDCap) 中。结果 34 个中心中有 31 个中心 (91%) 完成了调查，其中不完整字段极少。大多数 (61%) 的中心都有一个专用 CACU，其中 48% 的中心与重症监护病房相邻或相邻。 3:1 的护士人员配置比例最为常见 (71%)，大多数中心 (84%) 都聘用了一名资源护士。 84% 的中心使用集中式无线节律监测，其中 54% 的中心持续配备工作人员。在整个协作过程中，无创呼吸支持、血管活性输注和心室辅助装置的使用存在显着差异。大约一半的接受调查的中心有针对特定病变的术后路径，大约三分之二的中心有针对单心室患者的方案。结论 PAC(3) 医院调查是迄今为止对 CACU 独有的系统和护理实践的最全面的描述。单位组成之间存在相当大的异质性，护理实践也存在差异。这些变化可能有助于确定最佳实践并提高患者的护理质量。
Background The Pediatric Acute Care Cardiology Collaborative (PAC(3)) was established in 2014 to improve the quality, value, and experience of hospital-based cardiac acute care outside of the intensive care unit. An initial PAC(3) project was a comprehensive survey to understand unit structure, practices, and resource utilization across the collaborative. This report aims to describe the previously unknown degree of practice variation across member institutions. Methods A 126-stem question survey was developed with a total of 412 possible response fields across nine domains including demographics, staffing, available resources and therapies, and standard care practices. Five supplemental questions addressed surgical case volume and number of cardiac acute care unit (CACU) admissions. Responses were recorded and stored in Research Electronic Data Capture (REDCap). Results Surveys were completed by 31 out of 34 centers (91%) with minimal incomplete fields. A majority (61%) of centers have a single dedicated CACU, which is contiguous or adjacent to the intensive care unit in 48%. A nurse staffing ratio of 3:1 is most common (71%) and most (84%) centers employed a resource nurse. Centralized wireless rhythm monitoring is used in 84% of centers with 54% staffed continuously. There was significant variation in the use of noninvasive respiratory support, vasoactive infusions, and ventricular assist devices across the collaborative. Approximately half of the surveyed centers had lesion-specific postoperative pathways and approximately two-thirds had protocols for single-ventricle patients. Conclusions The PAC(3 )hospital survey is the most comprehensive description of systems and care practices unique to CACUs to date. There exists considerable heterogeneity among unit composition and variation in care practices. These variations may allow for identification of best practices and improved quality of care for patients.